Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance

Tanaka, Hidetaka; Matsushima, Reiko; Tamai, Hiroshi; Kajimoto, Yoshinaga

doi:10.1067/mpd.2002.122725

Cited by 74 publications

(67 citation statements)

References 27 publications

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“…28 Impaired cerebral oxygenation due to reduced cerebral hemodynamics in young CFS patients with OI during an active standing test was suggested from the findings of continuous measurement of cerebral oxygenated hemoglobin using near-infrared spectroscopy. 29 In the present study, low systolic and diastolic blood pressures were noted in OI patients with and without CFS compared with those in control subjects. Using 24-hour ambulatory blood pressure monitoring, Newton et al 30 have consolidated the evidence that lower blood pressure occurs in CFS patients, and lower nighttime blood pressure seems to be a significant problem that may lead to the enhanced diurnal variation.…”

Section: Discussionsupporting

confidence: 44%

Small Heart With Low Cardiac Output for Orthostatic Intolerance in Patients With Chronic Fatigue Syndrome

Miwa

Fujita

2011

Clinical Cardiology

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Background: The etiology of chronic fatigue syndrome (CFS) is unknown. Orthostatic intolerance (OI) is common in CFS patients. Recently, small heart with low cardiac output has been postulated to be related to the genesis of both CFS and OI. Hypothesis: Small heart is associated with OI in patients with CFS. Methods: Study CFS patients were divided into groups of 26 (57%) CFSOI(+) and 20 (43%) CFSOI(−) according to the presence or absence of OI. In addition, 11 OI patients and 27 age-and sex-matched control subjects were studied. Left ventricular (LV) dimensions and function were determined echocardiographically. Results:The mean values of cardiothoracic ratio, systemic systolic and diastolic pressures, LV end-diastolic dimension, LV end-systolic dimension, stroke volume index, cardiac index, and LV mass index were all significantly smaller in CFSOI(+) patients than in CFSOI(−) patients and healthy controls, and also in OI patients than in controls. A smaller LV end-diastolic dimension (<40 mm) was significantly (P < 0.05) more prevalently noted in CFSOI(+) (54%) and OI (45%) than in CFSOI(−) (5%) and controls (4%). A lower cardiac index (<2 L/min/mm 2 ) was more prevalent in CFSOI(+) (65%) than in CFSOI(−) (5%, P < 0.01), OI (27%), and controls (11%, P < 0.01). Conclusions: A small size of LV with low cardiac output was noted in OI, and its degree was more pronounced in CFSOI(+). A small heart appears to be related to the genesis of OI and CFS via both cerebral and systemic hypoperfusion. CFSOI(+) seems to constitute a well-defined and predominant subgroup of CFS.

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Section: Discussionsupporting

confidence: 44%

Small Heart With Low Cardiac Output for Orthostatic Intolerance in Patients With Chronic Fatigue Syndrome

Miwa

Fujita

2011

Clinical Cardiology

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“…A second possibility is that cerebral oxygenation is impaired in patients with POTS. This possibility has been documented in one group of young subjects using near-infrared spectroscopy and recording from probes placed over the forehead (50). It is unlikely that impaired cerebral oxygenation accounts for these symptoms in our patients.…”

Section: Discussionmentioning

confidence: 92%

Cerebral autoregulation is preserved in postural tachycardia syndrome

Schondorf¹,

Benoit²,

Stein³

2005

Journal of Applied Physiology

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autoregulation is preserved in postural tachycardia syndrome. J Appl Physiol 99: 828 -835, 2005. First published April 28, 2005 doi:10.1152/japplphysiol.00225.2005.-To test whether cerebral autoregulation is impaired in patients with postural tachycardia syndrome (POTS), we evaluated 17 healthy control subjects and 27 patients with POTS. Blood pressure, heart rate, and cerebral blood velocity (transcranial Doppler) were recorded at rest and during 80°h ead-up tilt (HUT). Static cerebral autoregulation, as assessed from the change in cerebrovascular resistance during HUT, was the same in POTS and in controls. The properties of dynamic cerebral autoregulation were inferred from transfer gain, coherence, and phase of the relationship between blood pressure and cerebral blood velocity estimated from filtered data segments (0.02-0.8 Hz). Dynamic cerebral autoregulation of patients with POTS did not differ from that of controls. The patients' dynamic cerebral autoregulation did not change over the course of HUT, despite increased tachycardia suggestive of worsening orthostatic stress. Inflation of military anti-shock trouser pants substantially reduced the tachycardia of patients with POTS without affecting cerebral autoregulation. Symptoms of orthostatic intolerance were reduced in one-half of the patients following military anti-shock trouser pants inflation. We conclude that cerebral perfusion and autoregulation in many patients with POTS do not differ from that of normal control subjects. cerebrovascular circulation; Fourier analysis; hemodynamics THE POSTURAL ORTHOSTATIC TACHYCARDIA syndrome (POTS) is a form of orthostatic intolerance that is characterized by symptoms of lightheadedness, fatigue, palpitations, diminished concentration, blurred vision, tremulousness, shortness of breath, nausea, and impaired cognition that mainly occur during upright posture (5,24,31,33). To qualify for the diagnosis of POTS, these symptoms must occur in conjunction with an increase in heart rate (HR) of Ͼ30 beats/min or a HR Ͼ 120 beats/min within the first 5 min of standing (23)(24)(25)31). The HR increase should be sustained and not associated with orthostatic hypotension (46). Many patients have evidence of hypovolemia (16,26) or exaggerated venous pooling with central hypovolemia (32,48). Inflation of military anti-shock trousers (MAST pants), which prevent venous pooling in the legs, usually causes reversal of the tachycardia (49). The pathophysiology of POTS is poorly understood. Various abnormalities have been described, including the presence of an attenuated autonomic neuropathy (25, 43), increased cardiac norepinephrine spillover (19), impaired norepinephrine transporter (45), or reduced vagal cardiac baroreflex sensitivity (14). Some patients may have evidence of increased sympathetic activity while supine (17, 18), whereas others do not (5).Regardless of pathophysiology, all patients with POTS are significantly disabled by the constellation of symptoms noted above (2).Lightheadedness and impaired concentration while ...

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“…The etiology is unknown, but recent evidence suggests that cardiovascular dysregulation may play an important role. Various forms of orthostatic intolerance have been demonstrated both in adult Peckerman et al 2003a) and pediatric Stewart et al 1999;Wyller et al 2007a) patients, as well as abnormalities in cerebral (Tanaka et al 2002), muscle (McCully et al 2004), and skin (Wyller et al 2007b) hemodynamics. Dysfunction of the autonomic nervous system, and particularly the sympathetic branch, has therefore been proposed as an important component of the pathophysiology (Freeman and KomaroV 1997).…”

Section: Introductionmentioning

confidence: 98%

Sympathetic cardiovascular control during orthostatic stress and isometric exercise in adolescent chronic fatigue syndrome

et al. 2007

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The chronic fatigue syndrome (CFS) has been shown to be associated with orthostatic intolerance and cardiovascular dysregulation. We investigated the cardiovascular responses to combined orthostatic stress and isometric exercise in adolescents with CFS. We included a consecutive sample of 15 adolescents 12-18 years old with CFS diagnosed according to a thorough and standardized set of investigations, and a volunteer sample of 56 healthy control subjects of equal sex and age distribution. Heart rate, systolic, mean and diastolic blood pressure, stroke index, and total peripheral resistance index were non-invasively recorded during lower body negative pressure (LBNP) combined with two consecutive periods of handgrip. In addition, we measured baseline plasma catecholamines, and recorded symptoms. At rest, CFS patients had higher heart rate, diastolic blood pressure, plasma norepinephrine (P < 0.01), mean blood pressure and plasma epinephrine (P < 0.05) than controls. During LBNP, CFS patients had a greater increase in heart rate, diastolic blood pressure, mean blood pressure (P < 0.05) and total peripheral resistance index (n.s.) than controls. During handgrip, CFS patients had a smaller increase in heart rate, diastolic blood pressure (P < 0.05), mean blood pressure and total peripheral resistance index (n.s.) than controls. Our results indicate that adolescents with CFS have increased sympathetic activity at rest with exaggerated cardiovascular response to orthostatic stress, but attenuated cardiovascular response when performing isometric exercise during orthostatic stress. This suggests that CFS might be causally related to sympathetic dysfunction.

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Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance

Cited by 74 publications

References 27 publications

Small Heart With Low Cardiac Output for Orthostatic Intolerance in Patients With Chronic Fatigue Syndrome

Small Heart With Low Cardiac Output for Orthostatic Intolerance in Patients With Chronic Fatigue Syndrome

Cerebral autoregulation is preserved in postural tachycardia syndrome

Sympathetic cardiovascular control during orthostatic stress and isometric exercise in adolescent chronic fatigue syndrome

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